Comprehensive evaluation of serum nutritional markers in predicting prognosis among cancer patients with cachexia

Abstract Purpose Our objective is to comprehensively assess the prognostic value of three serum nutritional markers including albumin, prealbumin, and transferrin in patients with cancer cachexia. Methods Concordance index and receiver operating characteristic curves were applied to compare the prognostic performance of different markers. The primary outcome was overall survival (OS), with comprehensive survival analyses were performed. The second outcomes were short-term survival and quality of life. Results This multicenter prospective cohort study included 1303 cancer cachexia patients, with 592 death cases during a median follow-up of 20.23 months. Albumin was the most accurate prognostic predictor, followed by transferrin and prealbumin. Multivariate Cox analysis confirmed that low albumin (hazard ratio = 1.55, 95% confidence interval = 1.31–1.84, P < 0.001), prealbumin (HR = 1.33, 95%CI = 1.11–1.59, P = 0.002), and transferrin (HR = 1.46, 95%CI = 1.22–1.74, P < 0.001) were independent risk factors associated with survival in cancer cachexia patients. The prognostic value of low albumin was significant in patients with upper gastrointestinal, hepatobiliary and pancreatic and colorectal cancers; low prealbumin was significant in colorectal cancer; and low transferrin was significant in patients with upper gastrointestinal and colorectal cancer. All three nutritional markers were valuable in predicting survival for patients in advanced stages. The risks of short-term mortalit and poor quality of life were significantly increased in patients with low serum nutritional markers. Conclusion Low albumin, prealbumin, and transferrin levels were all independent prognostic factors for patients with cancer cachexia, especially in advanced stages.